快樂小藥師 Im pharmacist nichts glücklich

The women's study showed that ibuprofen use and acetaminophen use were associated with increased risk of hearing loss, but aspirin use was not. Depending on the frequency of use, the relative risk of hearing loss from ibuprofen, with use more than 2 to 3 times per week, was up to 24% higher compared with use less than once per week. Depending on the frequency of use, the relative risk of hearing loss from acetaminophen, with use more than 2 to 3 times per week, was up to 21% higher compared with use less than once per week.

The men's study showed that regular use of aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen increases the risk of hearing loss. Depending on the frequency of use, the relative risk of hearing loss from aspirin, with use more than 2 times per week, was up to 12% higher compared with use less than twice per week. Depending on the frequency of use, the relative risk of hearing loss for NSAIDs, with use more than 2 times per week, was up to 21% higher compared with use less than twice per week. Depending on the frequency of use, the relative risk of hearing loss from acetaminophen, with use more than 2 times per week, was up to 22% higher compared with use less than twice per week.

The study authors commented that the findings could have important public health implications, as they suggest a potentially modifiable contributor of hearing loss.

The women's study can be found at Curhan SG et al. Analgesic use and the risk of hearing loss in women. Am J Epidemiol 2012; 176(6):544-554.

According to the study authors, more than 50% of adults in the U.S. suffer from high frequency loss by age 60. The prevalence is higher in men, but one-third of women in their 50s and almost two-thirds of women in their 60s suffer hearing loss. The authors state that the World Health Organization ranks adult-onset hearing loss as the sixth most common disease burden in higher-income countries.

Ibuprofen, acetaminophen and aspirin are commonly used pain relievers in the United States. Potential ototoxicity associated with these pain relievers has been described previously. The study authors indicate that damage to the cochlea or auditory nerve may result from several mechanisms such as impaired outer hair cell function, inhibition of prostaglandin-forming cyclooxygenase, and reduced cochlear blood flow. Potential ototoxicity from acetaminophen may be due to the depletion of glutathione. Evidently, glutathione has been shown to protect the cochlea from noise-induced damage. According to the study authors, the National Health and Nutrition Examination Survey from 1988-1994 reported that more than 80% of women age 25 or older reported having used nonprescription analgesics within the past month.

Given that the use of analgesics by women is so common, the study authors prospectively analyzed the association between analgesic use and the risk of hearing loss in 62,261 women. The authors examined the relation between frequency of aspirin, ibuprofen and acetaminophen use and risk of hearing loss among 62,261 women ages 31-48 at baseline in 1995. The outcome was self-reporting hearing loss between 1995 and 2009. Standard statistical tests were used to adjust for potential confounders such as alcohol consumption, smoking, hypertension, diabetes and menopausal status.

They determined the analgesic use as follows. On the 1995 questionnaire and those that followed every 2 years thereafter, women were asked about their average frequency of use of NSAIDs, acetaminophen and aspirin. In 1995, women were asked to report the number of days each month on which they used the individual analgesics. In 1997, women were asked about the average number of days per week of use (never, once/week, 2-3 times /week, 4-5 times/week, or equal to or greater than 6 times per week) of aspirin, NSAIDs and acetaminophen. In 1999 and thereafter, women were asked specifically about average use of ibuprofen and regular use of other NSAIDs. The main analysis examined frequency of use of ibuprofen, acetaminophen and aspirin.

The primary outcome was self-reported hearing loss and was determined on the basis of responses to the 2009 long-term form questionnaire. The questionnaire asked, "Do you have a hearing problem?". They defined incident cases as a reported hearing problem first noticed after 1995. The follow-up period was 1995-2009.

Results of the women's study

During 764,247 person-years of follow up, 10,012 cases of hearing loss were reported. Both ibuprofen use and acetaminophen use were independently associated with an increased risk of hearing loss, but aspirin use was not. Compared with women who used ibuprofen less than once per week, the risk of hearing loss increased in those demonstrating increasing frequency of ibuprofen use. Compared with women who used acetaminophen less than once per week, the risk of hearing loss increased in those demonstrating increasing frequency of acetaminophen use.

1. For ibuprofen, the relative risk of hearing loss was 13% higher for use 2-3 days per week, 21% higher for use 4-5 days per week and 24% higher for use equal to or greater than 6 days per week, compared with use less than once per week.
2. For acetaminophen, the relative risk of hearing loss was 11% higher for use 2-3 days per week, 21% higher for use 4-5 days per week and 8% higher for use equal to or greater than 6 days per week, compared with use less than once per week.
3. In this study, there was no evidence of hearing loss with aspirin use.
4. Regular use (defined as equal to or greater than 2 days per week) of other NSAIDs (naproxen and ketoprofen) was not significantly associated with an increased risk of hearing loss.
5. The association between hearing loss and regular use of more than one class of analgesics did not appear to be greater than the sum for use of each individual analgesic.

This prospective study showed that the use of ibuprofen or acetaminophen 2 or more times per week is associated with an increased risk of hearing loss in women and that the magnitude of risk tends to be greater with increasing frequency of use. The findings could have important public health implications as they suggest a potentially modifiable contributor of hearing loss.

The men's study can be found at Curhan SG et al. Analgesic use and the risk of hearing loss in men. Am J Med 2010; 123(3):231-237.

The study with men was also out of Brigham and Women's Hospital and supported by NIH. The study examined the association between self-reported professionally diagnosed hearing loss and regular use of aspirin, NSAIDs and acetaminophen in 26,917 men ages 40-74 years at baseline in 1986. Participants completed detailed questionnaires at baseline and every 2 years thereafter. Cases of new onset hearing loss were defined as those diagnosed after 1986.

Results of the men's study

During 369,079 person-years of follow up, 3,488 cases of hearing loss were reported. Regular analgesic use was defined as 2 or more times per week, of aspirin, NSAIDs and acetaminophen. Regular use of each analgesic was independently associated with an increased risk of hearing loss for all three types of analgesics.

1. The increased risk of hearing loss in participants who were regular users compared with participants who used the specified analgesic less than twice a week were 12% increased risk for aspirin, 21% increased risk for NSAIDs and 22% increased risk for acetaminophen.
2. For NSAIDs and acetaminophen, the risk of hearing loss increased with longer duration of regular use. Those who used aspirin regularly for 1-4 years were 28% more likely to develop hearing loss than those who did not use aspirin regularly; the risk did not increase further with longer duration of use.
3. Those who used NSAIDs regularly for 4 or more years were 33% more likely to develop hearing loss than those who did not use NSAIDs regularly.
4. The risk of hearing loss with 4 or more years of regular acetaminophen use also was 33% higher.
5. For aspirin, regular users less than 50 years of age and those between 50-59 years were 33% more likely to have hearing loss than were non-regular users.
6. For NSAIDs, regular users less than 50 years of age were 61% more likely, those between 50-59 years were 32% more likely, and those 60 years or older were 16% more likely to develop hearing loss than non-regular users.
7. For acetaminophen, regular users less than 50 years of age were 99% more likely, those 50-59 years 38% more likely, and those over 60 years were 16% more likely to have hearing loss than non-regular users.

The authors of the study concluded that in men, regular use of analgesics, specifically aspirin, NSAIDs and acetaminophen might increase the risk of hearing loss, particularly in younger individuals. Given the high prevalence of regular analgesic use and health and social implications of hearing impairment, this represents an important public health issue.

The authors did comment that the study was carried out in a population of predominantly white men and additional studies are needed to examine these associations in other racial groups.